Skype, biometrics, M-health and E-health are all set to make an entry into India’s primary health centres (PHCs) and sub-centres as the health ministry steps on the gas to go hi-tech.
To improve healthcare services in the remote parts of the country, the Planning Commission has suggested adopting telemedicine by using software applications such as Skype in its report on health for the 12th Five-Year plan. In its 12th Plan report, the Plan panel has suggested adopting telecom technologies for connectivity in the healthcare sector. The steering committee on health has said that in the 12th plan (2012-17), all district hospitals would be linked to leading tertiary care centres through telemedicine, Skype and similar audio visual media. M-health will be used to speed up transmission of data.
Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. Increased broadband availability and lower costs for the technology are helping telemedicine spread.
Narayana Hrudayalaya which pioneered the concept of telemedicine project in India using Indian Space Research Organization (ISRO) satellite has now switched over to video conferencing through the Skype. The move comes in to keep pace with the significant changes in the telemedicine transmission protocols. The cardiac care major started telemedicine using ISRO satellite in 2002-2003 and since then has treated over 53,000 patients in the remote locations.
Karnataka kicked off its first telemedicine project at the Narayana Hrudayalaya, to link Chamarajanagar district hospital and the Vivekananda Memorial Hospital, an non-government organisation (NGO) health unit at Saragur in HD Kote Taluk. The Karnataka Health and Family Welfare department financially supported the project. It was coordinated by the Karnataka State Remote Sensing Applications Centre (KSRSAC).
“Today by far, we have the largest experience in tele-cardiology. We have extended our services with the trans-telephonic ECGs to general practitioners in remote locations and today we get hundreds of ECGs everyday for interpretation from remote locations. But now we are not dependent on ISRO satellite any more. Five years ago, ISRO connected us to 54 cities in Africa through its Pan-African Satellite network. We are using this connectivity to educate healthcare professionals in Africa and also treat patients,” says Dr Devi Prasad Shetty, chairman, Narayana Hrudayalaya.
“However, now we have switched over to video conference mode through the Skype which is very inexpensive and easily available tool which can be done through laptops and mobile phones. Now we have regular tele-consultation with Skype at Dhaka other than several locations in India,” he added.
Microsoft is coming out with a whole new set of video technology shortly, the main highlight is that it will be SVC, which is scalable video compression. This is what video has right now which makes their product appealing. I is still not known if it is going to be embedded in Skype yet, but it will be in all their other products. As for video encryption, the whole concept is that you have to take responsibility as a provider of services that it is safe for clients. The minimum, as a rule of thumb, is AES 128 which both Skype and Facetime supports. The patient side of the equation is always the issue on disclosure and consent.
Indian Health Services
Cost of telemedicine has gone down significantly once the internet became ubiquitous and Skype became virtually free. “We believe that large hospitals are in a position to offer these services free of cost to reach out the patients and telemedicine should not be projected as a means of business to earn money to make it financially viable,” Dr Devi Shetty says.
India will also put in place a Citizen Health Information System (CHIS) – a biometric based health information system which will constantly update health record of every citizen-family. The system will incorporate registration of births, deaths and cause of death. Maternal and infant death reviews, nutrition surveillance, particularly among under-six children and women, service delivery in the public health system, hospital information service besides improving access of public to their own health information and medical records would be the primary function of the CHIS.
The steering committee on health has said in its report to the Planning Commission, “The overarching goal is to develop a biometric-based health information system, which constantly updates health record of every citizen-family, which begins with universal vital registration, which is portable and accessible to service providers and to the families themselves. Based on this foundation, a network links all service providers, public and private laboratories and also generates the figures needed at different levels for policy making as well as generates the alerts needed for disease surveillance.”
According to the committee, CHIS will incorporate information on service delivery in the public health system helping to make evidence-based and guideline compatible clinical decisions and make morbidity and mortality profile available. This will also help estimate burden of disease and facilitate policy decisions at state and national levels.
“Placed on a GIS platform, it can identify geographic concentration of disease. The system will also provide hospital information service to improve the quality of care to patients through electronic medical records, to lower response time in emergency and improve hospital administration. It will support emergency response systems and referral transport arrangements, the organ retrieval and transplantation programme,” it added.
The ministry plans to give a big push to support telemedicine services in primary, secondary and tertiary care. Disease surveillance based on reporting by providers and clinical laboratories (public and private) to detect and act on disease outbreaks and epidemics would be an integral component of the system.
“The system will also support financial management — from resource allocation, resource transfers, accounting and utilization to financial services like making of payments to facilities, providers and beneficiaries. It will provide a platform for continuing medical education and support regulatory functions of the state by creating a nation-wide registration of clinical establishments, manufacturing units, drug testing laboratories, licensing of drugs, approval of clinical trials,” the document added. firstname.lastname@example.org